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Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This project is supported by the Wellcome Trust and EPSRC Centre for Medical Engineering. Background QRS duration derived from 12-lead ECGs provides an estimate of the ventricular depolarization time and is an important metric to assess cardiac function. The QRS duration is determined in part by the combination of heart size and conduction velocity (CV). Differences in QRS duration in terms of gender, body mass index (BMI) and age have been well-documented, however, the relative impact of concurrent changes in heart size and CV on QRS duration is poorly understood. Cardiac digital twins, as in-silico replicas, provide a non-invasive physics and physiology-constrained framework to separate the impact of CV and heart anatomy on the QRS duration across populations. Purpose This study aims to identify the impact of CV and heart size on differences in QRS duration and quantify their difference in the general population in different groups of gender, BMI and age. Methods Patient-specific biventricular models (n=400) were constructed using long- and short-axis cardiac magnetic resonance (CMR) images from patients without self-reported cardiovascular diseases in the UK Biobank. Cardiac electrophysiology was simulated using a physiological-detailed model that includes fiber orientation, anisotropic conductivity, the His-Purkinje system activation, and fast endocardial conductivity[1]. 12-lead ECGs were reconstructed from the simulations and the QRS duration was computed based on corresponding vectorcardiogram (VCG) reconstructed from ECG data [2]. We calibrated patient-specific CVs to match the clinically measured QRS duration in ECGs at rest and then compare the heart size, QRS duration and estimated CVs for different patient groups. Results QRS duration was approx. 7% longer in males than females (median: 90ms vs 84ms, P Conclusions QRS duration is shorter in females and individuals with healthy weights. Most of the change in QRS duration can be explained by heart size, with the estimated CV remaining consistent across groups.

Funding Acknowledgements Type of funding sources: None. Background Given the crucial role of obesity as a risk factor for progression of cardiovascular disease (CVD), various guidelines have emphasized the importance of its prevention 1,2. The non-linear relationships of changes in weight, body mass index (BMI), and waist circumference (WC) to all-cause deaths were observed. Evidence on the associations of changes in obesity indices with CVD mortality is scarce. Purposes This study aimed to explore the linear and non-linear relationships of 1- and 3-year changes in obesity indices (i.e., weight, BMI, WC, waist-to-hip ratio (WHR), waist-to-hip ratio (WHRtR)), respectively, to CVD and all-cause mortality. Methods We included adults aged 18 - 65 years from an on-going longitudinal cohort in Taiwan. Multivariable logistics regression models and restricted cubic splines were used to explore the linear and non-linear associations of 1- and 3-year absolute and relative changes in weight, BMI, WC, WHR, and WHtR with CVD and all-cause mortality, respectively. Results A total of 18,024 participants were included in the 1-year change study, and 1,761 and 1,038 cases of all-cause and CVD mortality were reported (follow-up: 6 (range: 2 - 21) years). The 3-year study sample consisted of 12,695 participants, and 1,025 and 931 all-cause and CVD deaths were recorded (follow-up: 6 (range: 2 - 19) years). Results from multivariable logistics regression models showed that the CVD mortality risks were significantly reduced by 1-year absolute and relative increases in weight, BMI, WC, WHR, and WHtR. However, 3-year changes in WC and WHtR did not affect the risk of CVD deaths, while both absolute and relative increases in weight, BMI, and WHR were associated with a lower risk of CVD mortality. For all-cause mortality, any increase in obesity indices was associated with a reduced risk (Table 1). Additionally, restricted cubic splines visually showed U- and L-shaped relationships of changes in obesity indices to CVD and all-cause deaths. Risks of CVD mortality decreased until around 1-year changes of 2.1 cm (2.7%) in WC and 0.01 (2.8%) in WHtR and then increased. Also, below around 3-year change of 2.2 kg (2.5%) in weight, 0.7 kg/m2 (-1.6%) in BMI, 0.03 (3.5%) in WHR, and 0.03 (6.3%) in WHtR, the risks of CVD mortality went down with increases in obesity indices. Above the cut-off points, increased WHR and WHtR were associated with greater risks of CVD mortality. Moreover, an increase was a risk factor for CVD deaths among participants with increased WC of more than approximately 5.5 cm (6.3%) within three years. Similar trends were found among the relationships between changes in obesity indices with all-cause mortality (Figure 1-16). Conclusions We found U- and L-shaped relationships between changes in obesity indices and mortality from CVD and any cause. Risks of CVD and all-cause deaths decreased until a certain value of changes in obesity indices, especially central obesity indices, and then increased.

Background The current CNS WHO classification of brain tumors distinguishes three malignancy grades in meningiomas, with increasing risk of recurrence from CNS WHO grade 1 to 3. Radiotherapy is recommended by current EANO guidelines for patients not safely amenable to surgery or after incomplete resection in higher grades. Despite adequately predicting recurrence probability for the majority of CNS WHO grade 2 meningioma patients, a considerable subset of patients demonstrates an unexpectedly early tumor recurrence following radiotherapy. Methods A retrospective cohort of 44 patients with CNS WHO grade 2 meningiomas was stratified into 3 risk groups (low, intermediate, high) using an integrated morphological, CNV- and methylation family-based classification. Local progression-free survival (lPFS) following radiotherapy (RT) was analyzed and total dose of radiation was correlated with survival outcome. Radiotherapy treatment plans were correlated with follow-up images to characterize the pattern of relapse. Treatment toxicities were further assessed. Results Risk stratification of CNS WHO grade 2 meningioma into integrated risk groups demonstrated a significant difference in 3-year lPFS following radiotherapy between the molecular low- and high-risk group. Recurrence pattern analysis revealed that 87.5 % of initial relapses occurred within the RT planning target volume or resection cavity. Conclusion Integrated risk scoring can identify CNS WHO grade 2 meningioma patients at risk or relapse and dissemination following radiotherapy. Therapeutic management of CNS WHO grade 2 meningiomas and future clinical trials should be adjusted according to the molecular risk-groups, and not rely on conventional CNS WHO grading alone.

X-ray bursts are among the brightest stellar objects frequently observed in the sky by space-based telescopes. A type-I X-ray burst is understood as a violent thermonuclear explosion on the surface of a neutron star, accreting matter from a companion star in a binary system. The bursts are powered by a nuclear reaction sequence known as the rapid proton capture process (rp process), which involves hundreds of exotic neutron-deficient nuclides. At so-called waiting-point nuclides, the process stalls until a slower β+ decay enables a bypass. One of the handful of rp process waiting-point nuclides is 64Ge, which plays a decisive role in matter flow and therefore the produced X-ray flux. Here we report precision measurements of the masses of 63Ge, 64,65As and 66,67Se—the relevant nuclear masses around the waiting-point 64Ge—and use them as inputs for X-ray burst model calculations. We obtain the X-ray burst light curve to constrain the neutron-star compactness, and suggest that the distance to the X-ray burster GS 1826–24 needs to be increased by about 6.5% to match astronomical observations. The nucleosynthesis results affect the thermal structure of accreting neutron stars, which will subsequently modify the calculations of associated observables.

This study aimed to investigate Chinese physicians' perception and attitudes toward menopausal hormone therapy (MHT).This nationwide online survey was conducted in China. Physicians registered in the WeChat groups of the Gynecological Endocrinology Committee of China's Maternal and Child Health Care Association received a message invitation to complete this anonymous online survey from April 2020 to July 2020. Physicians' knowledge of and attitudes toward MHT were surveyed.In total, 4672 questionnaires were submitted; only completed questionnaires could be submitted. The message was sent to 6021 doctors, so the response rate was 77.6%. Overall, 77.9-92.9% of physicians knew the common indications and contraindications to MHT. Additionally, 90.6%, 85.4%, 80.7% and 37.5% of physicians thought that MHT would increase the risk of venous thrombosis, breast cancer, endometrial cancer and weight gain, respectively. In total, 58.1% of the physicians mistakenly believed that a sex hormone test was one of the necessary examinations to reassess MHT prescription during follow-up visits. We found that 68.5% of physicians would consider using MHT themselves or recommend MHT to their partners in the future, and 11.4% were currently using MHT.Most Chinese physicians have basic knowledge of MHT. Their misunderstandings about MHT mainly centered on the risks of endometrial cancer, weight gain and the necessary examinations during follow-up visits. These misunderstandings need to be clarified in future professional training programs.

The parathyroid and thymus are derived from the common primordia, the third pharyngeal pouch. During their development, endodermal cells actively interact with surrounding mesenchymal cells, mainly derived from neural crest cells (NCCs). However, the mechanism by which NCCs regulate the development of the third pharyngeal pouch remains largely unknown. In this study, we showed that fibronectin 1 ( Fn1), which is synthesized by NCCs, modulates the functions of NCCs in the third pharyngeal pouch patterning and in the morphogenesis of the thymus/parathyroid. Loss of Fn1 in NCCs leads to decreased Foxn1 expression in the presumptive thymus domain at E11.5. In the mutant, we detected upregulation of the Hedgehog signaling activity in the presumptive parathyroid domain and downregulation of Bmp4 in the presumptive thymus domain. Tbx1, a Hedgehog signaling target gene in endoderm development, was ectopically expanded to the presumptive mutant thymus domain at E11.5. Fgf10, an important gene regulating the proliferation of endoderm development, was downregulated in the mutant NCCs. At later organogenesis stages, derivatives of the third pharyngeal pouch endoderm of mutant embryos were abnormal, showing conditions such as hypoparathyroidism, hypoplastic thymus, and ectopic thymus and parathyroid. These data support that Fn1 plays an important role in NCCs by regulating the patterning of the third pharyngeal pouch and morphogenesis of the thymus/parathyroid.

Lung ischemia-reperfusion injury (LIRI)is a common complication after lung transplantation and cardiopulmonary bypass. It is an important factor affecting the success rate of transplantation. Its specific pathogenesis has not yet been fully elucidated. It is very significant to find the targets and drugs for the prevention and treatment of LIRI in order to improving the utilization rate of "marginal donor lung" and the long-term survival rate of lung transplant patients. Dipeptidyl peptidase 4(DPP4) inhibitors are a class of oral hypoglycemic agents. Previous studies have shown that DPP4 inhibitors have a variety of pharmacological activities, including anti-inflammatory, anti-fibrotic, immunomodulatory and other extrapancreatic functions. Recent studies have shown that DPP4 inhibitors may alleviate LIRI through various mechanisms, including inhibiting inflammatory responses, reducing oxidative stress, regulating blood glucose levels, and activating autophagy. This article reviewed the clinical and preclinical applications and mechanisms of DPP4 inhibitors in LIRI.肺缺血再灌注损伤（LIRI）是肺移植、体外循环术后常见并发症，是影响移植成功率的重要因素，但其具体发病机制目前尚未被完全阐明。寻找防治LIRI的靶点和药物，对提高“边缘性供肺”利用率和肺移植患者的远期生存率具有重要的临床意义。二肽基肽酶4（DPP4）抑制剂是一类口服降糖药，既往研究显示DPP4抑制剂具有多种药理活性，包括抗炎、抗纤维化、免疫调节等多种胰腺外功能。最近的研究显示DPP4抑制剂可能通过抑制炎症反应、减轻氧化应激、调控血糖水平和激活自噬等多种机制减轻LIRI。本文就DPP4抑制剂在LIRI中的临床及临床前应用和作用机制进行综述。.

Henan Province is one of the provinces where taeniasis and cysticercosis were historically highly prevalent, and

Background: Studying the growth and developmental mechanisms of steppe (Brandt’s) voles is important for biological control and protection of steppe ecology. In this paper, preliminary biological experiments’ data showed that the mortality of Brandt’s vole increased after retinoic acid treatment. Methods: LPH inhibitor, retinoic acid, quercetin and DMSO (Standard treatment concentration 10 mg/ml) were given them through oral with the help of Animal oral gavage feeding needles. The hind legs muscles of surviving Brandt’s voles were collected for transcriptomic analysis. Result: A total of 4047 and 2251 up- and down-regulated transcripts, respectively, were observed upon retinoic acid treatment compared to the DMSO (control) treatment. Transcriptomic changes were enriched significantly in 31 KEGG pathways, most of which were involved in sugar metabolism, particularly for fructose and mannose (ko00051), protein digestion and absorption (ko04974), phenylalanine metabolism (ko00360), tyrosine metabolism (ko00350) and the PI3K-Akt signaling pathway (ko04151), which is related to growth and development. A total of 114 differentially expressed genes were screened as candidate genes according to the enrichment results, including c-Jun N-terminal kinase and tubulin epsilon chain verified by RT-PCR. Ultimately, we proposed a preliminary regulatory molecular mechanism of retinoic acid relevant to mouse development and death.

This study was conducted to investigate the flow and heat transfer characteristics of a flat plate located between two symmetrical cylinders. Flow visualization experiments were conducted based on ...

Coronavirus disease 2019 (COVID-19) severely impacts physical and mental health of COVID-19 patients. This study aimed to investigate COVID-19 patient narratives to reveal how their lived experiences of COVID-19 infection and quarantine shape their mental health. In-depth semi-structural interviews were conducted with 5 COVID-19 patients from Wuhan to elicit their lived experiences of COVID-19. The case reports showed that persons diagnosed with COVID-19 infection and admitted to the COVID ward developed the symptoms of anxiety, worry, low mood, frustration, irritability, stigma, distress, guilt, and loneliness. Lack of scientific information, long-term social isolation, and limited social support were the main risk factors leading to their mental health problems. The study sug-gests that timely diagnosis of patients’ mental health problems and diverse psychological interventions are needed before, during, and after their hospitalization.

White spot lesions and enamel cracks are the 2 most prominent diseases that occur after orthodontic treatment and are caused by enamel demineralization from accumulated bacterial biofilms and/or enamel damage caused by the removal of residual adhesive after bracket debonding. Inspired by the self-assembled amelogenin nanoribbons in enamel, we developed an enamel coating with a self-assembling antimicrobial peptide, D-GL13K, to simultaneously reduce demineralization and residual adhesive. The self-assembled amphiphilic nanoribbons significantly increased the hydrophobicity of the etched enamel, which reduced the permeability of the coated enamel surfaces as desired. The antimicrobial activity of this coating was evaluated against Streptococcus mutans by colony-forming unit counting and live/dead assays. The anti-demineralization effect was demonstrated by the reduced demineralization depth analyzed by optical coherence tomography and the increased Vickers hardness. The coatings did not reduce the shear bond strength but significantly reduced the adhesive remnant index score. This bioinspired enamel coating may provide a new strategy for preventing white spot lesions and enamel cracks after orthodontic treatment.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Microvascular invasion (MVI) is considered the major risk factor for postoperative recurrence and metastasis in HCC. The diagnosis of MVI relies on the postoperative pathological assessment of the tumor tissues. Seeking non-invasive methods and biomarkers for evaluation of MVI before surgery has important clinical implications for guiding surgical treatment and improving patients' survival. Recent studies have reported the applications of radiomics technique in prediction of MVI in HCC and showed promising results. Herein we summarized the research progress in CT- or MRI-based radiomics models for prediction of MVI in HCC to provide helpful thinking for further research in this field.肝细胞癌是全球最常见的恶性肿瘤之一，微血管侵犯（MVI）是术后复发及转移的重要原因。MVI的诊断依靠术后肿瘤的病理学检查，术前寻求无创评估MVI的方法及生物标志物，对指导手术治疗和提高患者生存具有重要临床意义。近年来不少研究报道了利用影像组学预测肝细胞癌MVI，结果表明该技术在本领域具有一定的应用前景。现总结了近年来基于CT或MRI图像影像组学模型预测MVI研究结果，以期为该领域的进一步研究提供有益的思考。.

肝脏钙化性巢状间质-上皮肿瘤（calcifying nested stromal-epithelial tumor，CNSET）是一种非肝细胞、非胆管细胞原发的肝脏低度恶性潜能肿瘤，非常罕见。目前国外报道病例52例，国内报道仅2例。本文报道1例肝脏CNSET，并结合相关文献复习，以提高临床和病理医师对该肿瘤的认识水平，从而为患者的及时治疗提供机会。.

The incidence and mortality of HCC in China account for approximately 50% of all cases worldwide. Low early diagnosis rate and high postoperative recurrence rate are two major causes for poor 5-year survival rate of HCC patients in China. At present, multiple problems such as low performance and compliance of screening technology and lack of effective markers for predicting postoperative recurrence, remain to be resolved. Due to the simplicity and accuracy, new molecular markers, such as liquid biopsy, are expected to serve as supplementary tools to traditional screening and early warning approaches, thereby realizing early detection and accurate treatment of HCC. In this article, research progress upon the clinical application of liquid biopsy in early screening and prediction of postoperative recurrence of HCC was reviewed, and prospects the future research.中国肝细胞癌（HCC）发病及死亡人数约占全球50%。HCC早期诊断率低及术后复发率高是我国HCC患者5年生存率欠佳的两大原因。当前存在筛查技术性能及依从性较低、缺乏有效预测术后复发标志物等问题。液体活检等新型分子标志物因其简便、精准等特点，有望成为传统筛查预警方法的有益补充，实现HCC的早期发现及精准治疗。现就液体活检在HCC早筛及治疗后复发预测中的临床转化应用进行论述，并对未来研究进行展望。.

To investigate the epidemiological characteristics and identify the risk factors ofA cross-sectional study was performed for questionnaire surveys among colorectal cancer patients in Henan Cancer Hospital during the period from March to July, 2021. Patients' stool samples were collected, and the triosephosphate isomerase (A total of 307 colorectal cancer patients were investigated, including 176 males (57.3%) and 131 females (42.7%). PCR assay detected 8.1% [95% confidential interval (The prevalence of

The correlated f-electron compound URu2Si2 exhibits superconductivity (SC) with a critical temperature Tc = 1.5 K that coexists with the “hidden order” (HO) phase that forms below a characteristic temperature T0 = 17.5 K. The SC of URu2Si2 appears to be spin singlet chiral SC with d-wave order parameter symmetry, and the pairing of SCing electrons may involve spin excitations of the HO phase. Electrical resistance R measurements were performed on single crystal specimens of URu2−xFexSi2 with increasing x throughout the transition from the HO phase to the large moment antiferromagnetic LMAFM phase in high magnetic fields H oriented at various angles θ with respect to the tetragonal c-axis. Measurements of R(θ) at H = 20, 33, 40, and 45 T were conducted in the temperature range 0.33 ≤ T ≤ 20 K and showed θ-dependent behavior in the various phase transitions of URu2−xFexSi2 (HO, LMAFM, spin density wave, Fermi surface reconstruction, etc.). These phase transitions, as functions of T, H, and θ are plotted in a phase diagram of T vs. H//c = Hcosθ for multiple values of x and show that H//c, not θ is a tuning parameter of the URu2−xFexSi2 system throughout all Fe concentrations, as previously found by Scheereret al. for the URu2Si2 parent compound.

This study explored the first-person lived experiences of 2 nurses and 2 doctors combating coronavirus disease 2019 (COVID-19) in Wuhan, China. The in-depth interviews indicated that frontline healthcare professionals were at high risk of developing symptoms of fear, anxiety, depression, stress, loneliness, and burnout. The fear of being infected and the heavy workload in the isolation ward are the main risk factors for frontline health workers' psychological problems. Comprehensive assistance and social support must be provided in order to resolve their mental health issues.

Aims The vertical distribution of plant roots is a comprehensive result of plant adaptation to the environment. Limited knowledge on fine vertical root distributions and complex interactions between roots and environmental variables hinders our ability to reliably predict climatic impacts on vegetation dynamics. This study attempts to understand the drought adaptability of plants in arid areas from the perspective of the relationship between vertical root distribution and surroundings. Methods By analyzing root profiles compiled from published studies, the root vertical profiles of two typical phreatophytes, Tamarix ramosissima and Populus euphratica, and their relationships with environmental factors were investigated. A conceptual model was adopted to link the parameter distribution frequency with plant drought adaptability. Important Findings The strong hydrotropism (groundwater-dependent) and flexible water-use strategy of T. ramosissima and P. euphratica help both species survive in hyperarid climates. The differences in the developmental environments between T. ramosissima and P. euphratica can be explained well by the different distribution characteristics of root profiles. That is, higher root plasticity helps T. ramosissima develop a more efficient water-use strategy and therefore survive in more diverse climatic and soil conditions than P. euphratica. We conclude that the higher variation in root profile characteristics of phreatophytes can have greater root adaptability to the surroundings and thus wider hydrological niches and stronger ecological resilience. The inadequacy of models in describing root plasticity limits the accuracy of predicting the future response of vegetation to climate change, which calls for developing process-based dynamic root schemes in Earth system models.

Deep generative models with a specific variational autoencoding structure are capable of estimating parameters for the multidimensional logistic 2-parameter (ML2P) model in item response theory. In this work, we incorporated Q-matrix and variational autoencoder (VAE) to estimate item parameters with correlated and independent latent abilities, and we validate Q-matrix via the root mean square error (RMSE), bias, correlation, and AIC and BIC test score. The incorporation of a non-identity covariance matrix in a VAE requires a novel VAE architecture, which can be utilized in applications outside of education such as players performance evaluation, clinical trials assessment. Moreover, results show that the ML2P-VAE method is capable of estimating parameters and validating Q-matrix for models with a large number of latent variables with low computational cost, whereas traditional methods are infeasible for data with high-dimensional latent traits.

Pressure sensor used in marine hydrographic survey is an important device for the deep sea detection, the tsunami forecast and the marine engineering. Owing to its mature technology process and low...

Large numbers of quantitative trait loci (QTLs) for blood pressure (BP) exist and have long been thought to function by accumulating their individual miniscule effects. Recent experimental evidence in the functional biology of BP control has tested this intuitive assumption. A new paradigm has emerged that BP is biologically determined in modularity by multiple QTLs. Functionally, when a master regulator is taken out, distinct epistatic modules organize biological 'blocks' into a genetic architecture, and serve as basic functional cores from which numerous QTLs act together to physiologically formulate BP. An epistatic module refers to the grouping of QTLs that perform their functions epistatically to one another and influence BP as a group. The modularity mechanism framework indicates that BP as a quantitatively-measured trait is not cumulatively determined and implies that the QTLs in the same epistatic module may participate in the same pathway leading to the BP control, and the QTLs from separate epistatic modules may act in divergent but parallel pathways. This mechanistic conceptualization and subsequent validations synergize with anticipated demands from current human epidemiological studies, since the outcome from them primarily implicates single nucleotide polymorphisms with unknown functions. Eventually, functional understandings of the human results have to be realized by their pathogenic directionality and mechanisms biologically controlling BP.

The benefit and harm of three-field lymphadenectomy for oesophageal cancer are still unknown. The aim of this study was to compare overall survival and morbidity and mortality between three- and two-field lymphadenectomy in patients with oesophageal squamous cell carcinoma.Between March 2013 and November 2016, patients with squamous cell carcinoma of the middle or distal oesophagus were assigned randomly to open oesophagectomy with three-field (cervical-thoracic-abdominal) or two-field (thoracic-abdominal) lymphadenectomy. No chemo(radio) therapy was given before surgery. This paper reports on the secondary outcomes of the study: pathology and surgical complications.Some 400 patients were randomized, 200 in each group. A median of 37 (i.q.r. 30-49) lymph nodes were dissected in the three-field group, compared with 24 (18-30) in the two-field group (P0·001). Some 43 of 200 patients (21·5 per cent) in the three-field group had cervical lymph node metastasis. More patients in the three-field group had pN3 disease: 21 of 200 (10·5 per cent) versus 10 of 200 (5·0 per cent) (P = 0·040). The rate and severity of postoperative complications were comparable between the two groups, except that six patients in the three-field arm needed reintubation compared with none in the two-field group (3·0 versus 0 per cent; P = 0·030). The 90-day mortality rate was 0 per cent in the three-field group and 0·5 per cent (1 patient) in the two-field group (P = 1·000).Oesophagectomy with three-field lymphadenectomy increased the number of lymph nodes dissected and led to stage migration owing to a 21·5 per cent rate of cervical lymph node metastasis. Postoperative complications were largely comparable between two- and three-field lymphadenectomy. Registration number: NCT01807936 ( https://www.clinicaltrials.gov).El beneficio y los daños potenciales de la linfadenectomía en tres campos (three-field, 3-FLD) en el cáncer de esófago aún se desconoce. El objetivo de este estudio fue comparar la supervivencia global y la morbilidad y mortalidad entre la linfadenectomía en tres campos (3-FLD) y la linfadenectomía en dos campos (two-field lymphadenectomy, 2-FLD) en pacientes con carcinoma escamoso de esófago. MÉTODOS: Entre marzo de 2013 y noviembre de 2016, pacientes con carcinoma escamoso del tercio medio y distal del esófago fueron asignados de forma aleatoria a esofaguectomía abierta con linfadenectomía 3-FLD (cervical-torácica-abdominal) o 2-FLD (torácica-abdominal). No se administró quimioterapia o quimiorradioterapia antes de la cirugía. Este estudio describe los resultados secundarios: datos de la anatomía patología y complicaciones quirúrgicas.Se aleatorizaron un total de 400 pacientes a linfadenectomía 3-FLD y 2-FLD (200 pacientes en cada grupo). En el grupo de 3-FLD se disecaron una mediana (rango) de 37 (30-49) ganglios linfáticos en comparación con 24 (18-30) en el grupo de 2-FLD (P0,001). Un total de 43 de 200 (21,5%) pacientes en el grupo 3-FLD presentaron metástasis en los ganglios linfáticos (lymph node metastasis, LNM) cervicales. Más pacientes en el grupo 3-FLD presentaron un estadio de la enfermedad pN3 en comparación con el grupo 2-FLD: 21 de 200 (10,5%) versus 10 de 200 (5,0%), P = 0,040). La tasa y gravedad de las complicaciones postoperatorias fue comparable en ambos grupos, aparte de 6 pacientes en la rama 3-FLD que necesitaron reintubación (3,0%) en comparación con ninguno en el grupo 2-FLD (P = 0,030). La mortalidad a los 90 días fue del 0% en 3-FLD y del 0,5% (1 paciente en el grupo 2-FLD (P = 1,000). CONCLUSIÓN: La esofaguectomía con 3-FLD aumenta el número de ganglios linfáticos y conduce a una migración del estadio debido a la tasa de LNM cervicales del 21,5%. Las complicaciones postoperatorias fueron similares entre las linfadenectomías 3-FLD y 2-FLD.